04/22/2025 03:15 PM House HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| HB147 | |
| HB52 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 147 | TELECONFERENCED | |
| *+ | HB 141 | TELECONFERENCED | |
| += | HB 52 | TELECONFERENCED | |
| + | TELECONFERENCED |
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
April 22, 2025
3:05 p.m.
DRAFT
MEMBERS PRESENT
Representative Genevieve Mina, Chair
Representative Andrew Gray
Representative Zack Fields
Representative Donna Mears
Representative Mike Prax
Representative Justin Ruffridge
Representative Rebecca Schwanke
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
HOUSE BILL NO. 147
"An Act relating to the practice of naturopathy."
- HEARD & HELD
HOUSE BILL NO. 52
"An Act relating to the rights of minors undergoing evaluation
or inpatient treatment at psychiatric hospitals; relating to the
use of seclusion or restraint of minors at psychiatric
hospitals; relating to a report published by the Department of
Health; relating to inspections by the Department of Health of
certain psychiatric hospitals; and providing for an effective
date."
- HEARD & HELD
HOUSE BILL NO. 141
"An Act relating to universal changing facilities in public
buildings."
- BILL HEARING CANCELED
PREVIOUS COMMITTEE ACTION
BILL: HB 147
SHORT TITLE: PRACTICE OF NATUROPATHY
SPONSOR(s): REPRESENTATIVE(s) PRAX
03/21/25 (H) READ THE FIRST TIME - REFERRALS
03/21/25 (H) HSS, L&C, FIN
04/15/25 (H) HSS AT 3:15 PM DAVIS 106
04/15/25 (H) -- MEETING CANCELED --
04/22/25 (H) HSS AT 3:15 PM DAVIS 106
BILL: HB 52
SHORT TITLE: MINORS & PSYCHIATRIC HOSPITALS
SPONSOR(s): REPRESENTATIVE(s) DIBERT
01/22/25 (H) READ THE FIRST TIME - REFERRALS
01/22/25 (H) HSS, L&C
03/25/25 (H) HSS AT 3:15 PM DAVIS 106
03/25/25 (H) Heard & Held
03/25/25 (H) MINUTE(HSS)
04/03/25 (H) HSS AT 3:15 PM DAVIS 106
04/03/25 (H) Heard & Held
04/03/25 (H) MINUTE(HSS)
04/22/25 (H) HSS AT 3:15 PM DAVIS 106
WITNESS REGISTER
REPRESENTATIVE MIKE PRAX
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: As prime sponsor, presented HB 147.
RILEY NYE, Staff
Representative Mike Prax
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: On behalf of Representative Prax, prime
sponsor, presented the sectional analysis of HB 147.
LAURA CULBERSON FARR, Executive Director
American Association of Naturopathic Physicians
Washington, D.C.
POSITION STATEMENT: Testified in support of HB 147.
GLENN SAVIERS, Deputy Director
Division of Corporations, Business, and Professional Licensing
Department of Commerce, Community & Economic Development
Juneau, Alaska
POSITION STATEMENT: Gave invited testimony in support of HB
147.
CLYDE JENSEN, PhD, Professor
National University of Natural Medicine
Happy Valley, Oregon
POSITION STATEMENT: Testified in support of HB 147.
SHANNON BRADEN, ND, Board Member
The Federation of Naturopathic Medicine Regulatory Authorities
Portland, Oregon
POSITION STATEMENT: Testified in support of HB 147.
NATALIE WIGGINS, ND, Board Member
Alaska Association of Naturopathic Doctors
Anchorage, Alaska
POSITION STATEMENT: Gave invited testimony in support of HB
147.
REPRESENTATIVE MAXINE DIBERT
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: As prime sponsor, presented HB 52.
MATTIE HULL, Staff
Representative Maxine Dibert
Juneau, Alaska
POSITION STATEMENT: On behalf of Representative Dibert, prime
sponsor, answered questions regarding HB 52.
ROBERT NAVE, Operations Manager
Division of Health Care Services
Department of Health
Anchorage, Alaska
POSITION STATEMENT: Answered questions regarding HB 52.
ACTION NARRATIVE
3:49:28 PM
CHAIR GENEVIEVE MINA called the House Health and Social Services
Standing Committee meeting to order at 3:49 p.m.
Representatives Mears, Schwanke, Ruffridge, Prax, and Mina were
present at the call to order. Representatives Gray and Fields
arrived as the meeting was in progress.
HB 147-PRACTICE OF NATUROPATHY
3:50:05 PM
CHAIR MINA announced that the first order of business would be
HOUSE BILL NO. 147, "An Act relating to the practice of
naturopathy."
3:50:28 PM
REPRESENTATIVE MIKE PRAX, Alaska State Legislature, as prime
sponsor, read the sponsor statement [hard copy included in the
committee file] for HB 147, which read as follows [original
punctuation provided]:
House Bill 147 allows licensed Alaska naturopathic
doctors to apply for a temporary endorsement to
practice closer to their level of education and
training. This will enable Alaskans to choose their
preferred healthcare style and help alleviate the
shortage of primary care providers in the state.
Approximately 50 licensed naturopaths provide
effective care for thousands of Alaskans with chronic
diseases like obesity, diabetes, and hypertension in
an overburdened healthcare system. However, current
limitations on naturopathic care require patients to
schedule duplicate appointments for prescriptions
increasing healthcare congestion and costs.
HB 147 allows licensed naturopaths to obtain a
temporary license endorsement through a written
agreement with a supervising physician. This
endorsement prohibits the prescription of controlled
substances, chemotherapy drugs, antipsychotic drugs,
radioactive substances, and performing invasive
surgeries. After one year under this agreement,
licensed Alaska naturopaths may get an ongoing
endorsement linked to the regular licensing renewal
process.
The legislation requires all licensed Alaska
naturopaths to complete sixty hours of continuing
education every two years, including twenty hours in
pharmacotherapy.
HB 147 authorizes state licensing personnel to suspend
or revoke an endorsement after investigating a
complaint against a licensed naturopath. The
legislation also makes prescribing medicine without an
endorsement illegal and addresses fraudulent actions
to obtain an endorsement.
Naturopathic education emphasizes holistic disease
prevention rather than simply treating symptoms. In
the long term, naturopathic care offers affordable and
enhanced health outcomes for patients, insurers, and
the state, while providing Alaskans the opportunity to
select the type of healthcare that best suits their
needs.
Please join me in supporting House Bill 147.
3:55:23 PM
RILEY NYE, Staff, Representative Mike Prax, on behalf of
Representative Prax, prime sponsor, gave the sectional analysis
[included in the committee file] for HB 147, which read as
follows [original punctuation provided]:
Section 1 adds new sections AS 08.45.033(Issuance of
Temporary Endorsement) and AS 08.45.034 (Issuance of
Endorsement)
Creates a new section of Alaska law to allow
licensed Alaska naturopaths to apply for a temporary
endorsement to prescribe a limited range of
prescription medications upon showing they have:
• passed the pharmacology portion of the
Naturopathic Physicians Licensing Exam or equivalent
test, and
• meet other applicable requirements established
by the Division of Corporations, Business and
Professional Licensing (DCBPL or Division).
Naturopaths holding a valid temporary endorsement may
prescribe a limited range of prescription medications
under a written collaborative agreement with a
licensed Alaska physician who has been prescribing and
administering prescription drugs for at least five
years. The collaborative physician will evaluate the
naturopath's prescriptive practice and provide
feedback. The temporary endorsement must be in place
for a minimum of twelve months and the collaborative
oversight must be reported on a form approved by
DCBPL. At the conclusion of the twelve-month period,
the collaborative physician is required to recommend
to DCBPL whether the naturopath should receive further
supervision, be issued an endorsement, or be denied an
endorsement. The temporary endorsement terminates on
the date a naturopath is issued, or denied, an
endorsement to prescribe. After considering the
recommendation of a collaborative physician, DCBPL
will determine whether to issue, or deny, an
endorsement to a naturopath or require further
prescriptive supervision. A naturopath who receives an
endorsement to prescribe and administer may do so
under the limitation of AS 08.45.050.
Section 2 adds new sections AS 08.45.037 (Continuing
Education Requirements) and AS 08.45.038 (Standards
for License Renewal) Creates a new requirement for all
licensed naturopaths in Alaska to provide proof of
completing sixty hours of division-approved continuing
education as part of their biannual license renewal
process. The required sixty hours must include a
minimum of twenty hours of continuing education
focused on pharmacotherapy. DCBPL may exempt a
naturopath from a portion of this ongoing training for
extenuating circumstances. However, DCBPL may not
grant an exemption for more than fifteen hours total
in a fouryear period. This partial waiver provision is
similar to statutory provisions for other medical
professionals in Alaska that acknowledge the potential
for serious illness, military service, family
emergencies or natural disasters to limit an ability
to complete some continuing medical education. This
section also establishes standards for license renewal
that require naturopaths to pay an appropriate fee,
show they meet the continuing education requirements,
disclose whether they have been found to have
perpetrated a crime that adversely reflects on their
ability to practice safely and have a current
cardiopulmonary resuscitation certificate.
Section 3 amends AS 08.45.050 (Restrictions on
Practice of Naturopathy) Amends existing law to
clarify that naturopaths prescribing and administering
medications under a temporary, or ongoing,
prescription endorsement may NOT prescribe:
1. a prescription drug except as allowed under their
temporary or ongoing prescriptive endorsement,
2. a poison,
3. a chemotherapy drug
4. an antipsychotic drug, or
5. administer a therapeutic ionizing radiation or
radioactive substance. In addition, existing statutory
prohibitions against a naturopath engaging in surgery
or using the word "physician" in the person's title
are preserved in law.
Section 4 amends AS 08.45.060 (Grounds for Suspension,
Revocation, or Refusal to Issue a License) Expands
existing Alaska law to clarify that DCBPL has full
authority to take disciplinary action against a
temporary, or ongoing, prescriptive endorsement held
by a licensed Alaskan naturopath if the division
determines the endorsement was secured through deceit,
fraud, or intentional misrepresentation.
Section 5 amends AS 08.45.070(a) (Disciplinary
Sanctions) Expands existing Alaska law to clarify that
DCBPL can exercise the same disciplinary authority
over a naturopath's temporary, or ongoing,
prescriptive endorsement as it does over a
naturopath's license to practice. This authority
allows the division to revoke, suspend, censure or
reprimand the licensee as well as place them on
probation that limits their practice or requires
additional professional training and reporting.
Section 6 amends AS 08.45.070(c) (Disciplinary
Sanctions) Expands existing Alaska law to clarify that
DCBPL can summarily suspend a temporary, or ongoing,
prescriptive endorsement during a final hearing or
appeals process if the division determines doing
otherwise would endanger the public health.
Section 7 amends AS 08.45.080 (Unlicensed Practice a
Misdemeanor) Expands existing Alaska law to clarify
that a licensed Alaska naturopath is guilty of a class
A misdemeanor if they are found to have prescribed a
prescription medication without having a valid
temporary, or ongoing, endorsement to do so.
Section 8 amends AS 08.45.090 (Fraudulent License)
Expands existing Alaska law to clarify that a
naturopath who obtains, or attempts to obtain, a
temporary endorsement to prescribe prescription
medications fraudulently is punishable by a fine of
not more than five hundred dollars or by imprisonment
for not more than six months, or both.
4:02:06 PM
REPRESENTATIVE GRAY raised concern about excluding chemotherapy
and antipsychotic drugs from the scope of naturopaths. He said
that it would be beneficial for these physicians to be allowed
to prescribe these drugs as they serve purposes outside of their
original intended use.
4:03:28 PM
REPRESENTATIVE PRAX deferred to an expert on pharmacy to answer
that question.
4:04:13 PM
CHAIR MINA announced invited testimony.
4:04:55 PM
LAURA CULBERSON FARR, Executive Director, American Association
of Naturopathic Physicians, testified in support of HB 147. She
explained that naturopathic doctors (NDs) have prescribing
authority in 15 jurisdictions and in some states NDs have nearly
if not equal prescribing authority as medical doctors (MDs).
She emphasized that HB 147 would not be an "experiment" for NDs
in the country. She said that many NDs have more pharmacology
course hours than others with prescribing authority, stating
that that hour comparison is not enough to determine
prescription authority. She said that while NDs do not have a
residency requirement, residencies do not equate to prescribing
authority, as other states allow certain occupations to
prescribe drugs without residencies, such as physician
assistants. She emphasized the history of safe prescriptions by
NDs in other states.
4:10:19 PM
REPRESENTATIVE SCHWANKE asked about the history of ND's full
prescriptive authority in Vermont.
MS. FARR responded that Vermont passed their prescribing
authority legislation in 2012, a bill which HB 147 is modeled
after. She said that since 2012, ND prescription has gone
smoothly with no restrictions.
4:12:26 PM
REPRESENTATIVE GRAY described his prescribing authority as a
physician's assistant (PA) and said HB 147 does not ask for that
much; it is "a modest bill."
REPRESENTATIVE SCHWANKE asked what would happen if a supervising
MD requested that the ND under their supervision does not
utilize their prescribing authority.
4:14:05 PM
GLENN SAVIERS, Deputy Director, Division of Corporations,
Business, and Professional Licensing, Department of Commerce,
Community & Economic Development, responded that the particular
circumstances would need to be considered. She explained that
there would be an investigation, and each case would be treated
individually.
4:15:11 PM
CLYDE JENSEN, PhD, Professor, National University of Natural
Medicine, testified in support of HB 147. He spoke from his own
experience to compare the pharmacology education NDs and MDs
receive, explaining they are held to the same standards of care
and require the same number of classroom hours. He stated that
NDs are supervised by other NDs, who have experience also
prescribing treatments other than drugs, while MDs are often
expected to prescribe drugs as treatments. He stated that
ongoing education is expected of all physicians across the
country and emphasized that NDs are equally educated and
qualified to prescribe drugs.
4:20:27 PM
MR. JENSEN spoke to Representative Gray's previous question
regarding drugs that could be useful for NDs to be allowed to
prescribe but would be excluded from their prescriptive
authority under HB 147. He said that NDs have always faced
opposition from "conventional medical professions" when seeking
prescriptive authority and he believes the intent of HB 147
would be to reduce the opportunity for opposition or debate.
4:21:20 PM
SHANNON BRADEN, ND, Board Member, Federation of Naturopathic
Medicine Regulatory Authorities (FNMRA), provided an overview of
the federation and its disciplinary authorities regarding NDs.
She stated that the FNMRA supports HB 147. She said that in
Oregon over the past 7 years, NDs received far fewer
disciplinary actions compared to MDs and other physicians. She
said that between 2010-2024, in states where NDS have broad
prescriptive rights, there were zero disciplinary actions taken
against NDs for inappropriate prescribing. She emphasized that
similar results would be expected in Alaska under HB 147.
4:26:54 PM
NATALIE WIGGINS, ND, Board Member, Alaska Association of
Naturopathic Doctors, testified in support of HB 147.. She began
by describing the healthcare crisis in Alaska, attributing such
high costs to the limited access to care in the state. She
stated that NDs are ready and able to fill that gap but are
prohibited by their limited scope of practice. She described
the rigorous education and training required by NDs, including
their education in pharmacology and medication management.
While some argue that this training does not equate to residency
experience, she argued that residency experience does not equate
to safe prescriptions. Dr. Wiggins stated that HB 147 would be
a cautious and reasonable step forward for NDs. She explained
that limiting the prescriptive authority of NDs places a burden
on patients, often requiring additional appointments to receive
necessary prescriptions from other physicians.
4:33:41 PM
REPRESENTATIVE GRAY offered his experience in emergency care and
the demand he faced from patients to prescribe medications. He
stated that he believes people who visit a naturopath are less
likely to ask for prescription medications. He asked if any
testifiers could speak to that point.
4:35:38 PM
DR. WIGGINS responded that there is a very thoughtful process
NDs take when making prescriptions, which includes taking the
time to consider non-medication treatment options.
4:36:41 PM
REPRESENTATIVE SCHWANKE spoke about people self-diagnosing and
getting medication online and asked whether HB 147 would
encourage those people to seek care from NDs instead.
DR. WIGGINS answered that that is absolutely true.
4:38:50 PM
CHAIR MINA announced that HB 147 was held over.
HB 52-MINORS & PSYCHIATRIC HOSPITALS
4:38:55 PM
CHAIR MINA announced that the final order of business would be
HOUSE BILL NO. 52, "An Act relating to the rights of minors
undergoing evaluation or inpatient treatment at psychiatric
hospitals; relating to the use of seclusion or restraint of
minors at psychiatric hospitals; relating to a report published
by the Department of Health; relating to inspections by the
Department of Health of certain psychiatric hospitals; and
providing for an effective date."
4:39:22 PM
REPRESENTATIVE GRAY moved to adopt the proposed committee
substitute (CS) for HB 52, Version 34-LS0399\I, Radford,
4/12/25, as the working document.
CHAIR MINA objected for the purpose of discussion.
4:39:49 PM
REPRESENTATIVE MAXINE DIBERT, Alaska State Legislature, as prime
sponsor, provided a brief recap of HB 52 and thanked the
committee for the support she has seen for the bill so far. She
emphasized that the goal of HB 52 is to protect the state's most
vulnerable youth receiving care from psychiatric facilities,
while also protecting the rights of their guardians.
4:42:01 PM
MATTIE HULL, Staff, Representative Maxine Dibert, on behalf of
Representative Dibert, prime sponsor, read the summary of
changes from the original bill version to Version I of HB 52
[included in the committee file], which read as follows
[original punctuation provided]:
Section 1
Page 2, line 1
Following charge. Inserts: The minor, the minor's
parent or legal guardian, or another adult approved by
the professional person in charge may request the
confidential communication.
Page 2, line 4:
Following Communication. Deletes "May place reasonable
limits on the number of calls permitted,"
Section 4
Page 3, line 13:
Following subsection. Inserts: Unless the department
of health requests staff presence during the interview
to ensure safety.
Section 5
Page 3, line 19
Inserts 72 hours as a replacement for "one business
day", which is deleted.
Section 6
Inserts: AS 47.32.900 Is amended by adding a new
paragraph to read:
(22) "chemical restraint" means a psychopharmacologic
drug that is used on a patient for restraint,
discipline, or convenience and that is not required to
treat a medical symptom.
Section 7
Page 3, Line 27:
Inserts "2026" as a replacement for 2025 which is
deleted.
4:44:33 PM
REPRESENTATIVE GRAY, referring to page 3, lines 25-26, in
Section 6 of HB 52, Version I, pointed to the language "that is
not required to treat a medical symptom". He said that
increasing the dosage of a medication that is already prescribed
to a child could be used as a restraint. He asked if this
language would create a loophole to inappropriately administer
an already prescribed drug.
4:45:20 PM
MR. HULL responded that there must be "an assumption of good
faith" for these institutions and he was advised by Legislative
Legal Services to finalize this language.
4:46:08 PM
REPRESENTATIVE RUFFRIDGE asked about other legislation that
already governs the use of psychotropic medications in crisis
situations. He asked if HB 52 and that existing legislation
would conflict with each other.
4:48:17 PM
MR. HULL responded that HB 52 would require the reporting of
chemical restraint usage but would not prohibit institutions
from providing care. He said that the usage of chemical
restraints would need to be reported under HB 52, even is used
in a crisis situation.
4:49:01 PM
REPRESENTATIVE FIELDS asked about the difference between
requiring one hour versus two hours of communication between a
patient and their legal guardian.
4:50:04 PM
MR. HULL responded that HB 52 would create a minimum requirement
for communication allowed but would not create a maximum
requirement.
4:51:04 PM
CHAIR MINA asked how that hour of communication would be
monitored or recorded. She asked if that would be done by the
facility of by the Division of Health Services.
MR. HULL offered his understanding that it would be monitored by
the hospital.
4:52:06 PM
ROBERT NAVE, Operations Manager, Division of Health Care
Services, Department of Health, responded that the hospital
would track the one-hour time limit.
4:52:38 PM
REPRESENTATIVE GRAY explained that sometimes requiring a young
child to talk on the phone for even five minutes can be very
difficult. He asked about the possibility of a phone call
including that child engaging in their own activities while
their guardian simply stays connected on the line.
4:53:17 PM
REPRESENTATIVE RUFFRIDGE asked about the purpose of a
psychiatric hospital notifying the Department of Health (DOH) of
any use of chemical restraint. He said he does not know the
case of another healthcare entity that is required to report
their administered healthcare to DOH. He asked what DOH would
do with that reported information.
4:55:09 PM
MR. HULL responded that psychiatric hospitals have shown a
history of abuse of children in their facilities. He said that
HB 52, at its core, would seek more transparency from
psychiatric facilities.
4:56:41 PM
REPRESENTATIVE DIBERT added that she would often see the nurses
in her own schools writing up reports to send on to higher
supervision, creating transparency. She also stated that
requiring reports would create more timely responses to
inappropriate administration of chemical restraints.
REPRESENTATIVE RUFFRIDGE agreed that the timeliness of this
reporting, especially to the patient's family, is extremely
important. He asked what DOH is going to do with this
information. He asked how this reporting to DOH accomplishes
the intended goal of HB 52.
4:59:31 PM
CHAIR MINA clarified that DOH would be required to submit their
report to the legislature, which would also become available
online.
4:59:54 PM
REPRESENTATIVE GRAY, in response to Representative Ruffridge's
question, discussed his experience reporting patient treatment
to DOH, adding that there is typically some level of follow-up
from DOH. He said that he believes requiring the report itself
may reduce the use of chemical restraints. He agreed that the
committee should consider who this report would be submitted to.
5:02:12 PM
MR. NAVE responded that currently when DOH receives reports of
chemical restraint usage, it determines whether that restraint
was justified or unjustified. He said if the determines that
the restraint was unjustified, it conducts an unannounced
investigation.
5:03:22 PM
REPRESENTATIVE PRAX asked about the requirement to notify
guardians of chemical restraint use within 72 hours. He said
that guardians may want to know more immediately than that. He
asked about unintended consequences of this 72-hour requirement
and about how DOH responds to these notifications.
MR. NAVE responded that DOH triages the reports it receives to
determine the priority of conducting on-site investigations.
REPRESENTATIVE DIBERT clarified that HB 52 originally asked for
a report within 24 hours of chemical restraint usage, but one
psychiatric hospital asked for 7 days, so 72 hours was a
compromise.
REPRESENTATIVE PRAX asked if DOH agrees that this timeframe
would be a reasonable compromise.
MR. NAVE responded that 72 hours is a reasonable timeline.
5:08:14 PM
CHAIR MINA removed her objection to the motion to adopt the
proposed CS for HB 52, Version 34-LS0399\I, Radford, 4/12/25,as
the working document. There being no further objection, Version
I was before the committee.
[HB 52 was held over.]
5:08:51 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at [5:09] p.m.